NAC 439.010Submission of petition to Secretary of State Board of Health. (NRS 439.200)Any
interested persons who desire the adoption, filing, amendment or repeal of any
regulation of the State Board of Health may petition the Board by a signed
letter to the Secretary of the Board, accompanied by relevant data, views and
arguments. Eight copies must be presented.

NAC 439.020Mailing of petition to members of State Board of Health. (NRS 439.200)The
Secretary of the State Board of Health shall mail to each member of the Board a
copy of the petition and accompanying material within 15 days after its
receipt.

NAC 439.030Action on petition by Secretary of State Board of Health. (NRS 439.200)

1. The Secretary of the State Board of
Health shall, within 45 days after receipt of the letter submitted pursuant to NAC 439.010, either deny the petition in writing,
stating the reasons, or initiate the procedure for the adoption, amendment or
repeal of regulations.

2. If the petition is denied, a copy of the
letter of denial must be sent to each member of the Board.

NAC 439.100Submission of petition to Secretary of State Board of Health. (NRS 439.200)

1. Any person with a direct and tangible
interest in the applicability of any statutory provision, regulation of the
State Board of Health or decision of the Division of Public and Behavioral
Health of the Department of Health and Human Services who desires a declaratory
order or advisory opinion as to that applicability may petition for the order
or opinion by letter to the Secretary of the Board.

NAC 439.110Mailing of petition to members of State Board of Health. (NRS 439.200)The
Secretary of the State Board of Health shall mail to each member of the Board a
copy of the letter submitted pursuant to NAC 439.100
within 15 days after its receipt.

NAC 439.120Action on petition by Secretary of State Board of Health. (NRS 439.200)

1. The Secretary of the State Board of
Health shall, within 45 days after receipt of the letter submitted pursuant to NAC 439.100, issue a temporary declaratory order or an
advisory opinion and mail it to the petitioner.

2. A copy of each order or opinion must be
mailed to each member of the Board.

1. The Secretary of the State Board of
Health shall mail to each member of the Board, at least 10 days before a
scheduled meeting of the Board, a copy of the agenda for that meeting, with any
supporting documents.

2. Information or material relating to an
item on the agenda which is received by the Secretary of the Board after the
agenda is mailed must be presented to the Board at the meeting. The Secretary
shall notify the person who submits the information or material that it will be
so presented.

3. Consideration of any material submitted
to the Secretary after the agenda is mailed may be continued by the Board to
the next meeting.

(Added to NAC by Bd. of Health, eff. 5-5-86)

NAC 439.160Incomplete applications. (NRS 439.200)The
Secretary of the State Board of Health shall return to the applicant any
incomplete application submitted to the Board with:

1. An explanation of the deficiencies in the
application;

2. A request that a complete application be
resubmitted;

3. A statement notifying the applicant that
any information received by the Secretary later than 15 days before a scheduled
meeting of the Board may be presented to the Board at that meeting but
consideration of the matter may be continued by the Board to its next meeting;
and

4. A statement that the Division of Public
and Behavioral Health of the Department of Health and Human Services recommends
the continuance of consideration of an incomplete application.

1. The Secretary of the State Board of
Health may place on a consent calendar each uncontested item which receives a
recommendation of approval from the Division of Public and Behavioral Health of
the Department of Health and Human Services.

2. Any item placed on the consent calendar
may be removed from that calendar for more detailed consideration. Related
items will be considered together.

(Added to NAC by Bd. of Health, eff. 5-5-86; A by R010-06,
5-4-2006)

NAC 439.180Order of testimony for considering matter. (NRS 439.200)In
considering a matter, the State Board of Health will hear from interested
persons in the following order:

1. Reports and recommendations of the
Division of Public and Behavioral Health of the Department of Health and Human
Services.

2. Comments by the person who is requesting
action by the Board, or the person’s representative.

1. Except as otherwise provided in this
section, in any administrative hearing that the State Board of Health is
required to hold, the procedures for hearing officers set forth in NAC 439.300 to 439.395,
inclusive, apply.

2. In any administrative hearing that the
State Board of Health is required to hold:

(a) A request for a hearing must be addressed to
the Administrator as the Executive Secretary of the Board and must be received
within the period prescribed by statute or regulation. The request must specify
the reasons that the appellant is requesting a hearing.

(b) Upon receipt of the request for a hearing, the
Executive Secretary shall schedule the matter to be heard at a public hearing
held:

(1) At the next regularly scheduled meeting of
the Board;

(2) At the next meeting of the Board held in
Las Vegas or Reno, as requested by the appellant; or

(3) As soon thereafter as the schedule of the
Board allows.

(c) Written notice of the date of the hearing must
be served by personal delivery to the appellant or by mailing the notice by
registered or certified mail to the last known residential or business address
of the appellant.

1. Except as otherwise provided in
subsection 2, documentary evidence may not be submitted at any hearing convened
by the State Board of Health unless it is submitted to the Board’s Secretary at
least 15 days before the date scheduled for the hearing.

2. The Board may waive the provisions of
subsection 1 if:

(a) The party in good faith, exercising due
diligence, was unable to secure the documentary evidence before the 15-day
deadline; and

(b) The Board is satisfied that the submittal of
the documentary evidence at the hearing will result in a substantial benefit to
the Board in rendering an informed decision.

3. The Board may continue the hearing to a
date certain if it determines additional time is needed to review an authorized
submittal of documentary evidence before rendering a decision.

(Added to NAC by Bd. of Health, eff. 7-22-87)—(Substituted
in revision for NAC 439.445)

1. Any person who, because of unique
circumstances, is unduly burdened by a regulation of the State Board of Health
and thereby suffers a hardship and the abridgment of a substantial property
right may apply for a variance from the regulation.

2. An application for such a variance must
be made to the State Board of Health unless the regulation is enforced by a
district board of health, in which case the application must be made to the
appropriate district board.

1. The Secretary of the State Board of
Health shall provide public notice of the application and the date of the
public hearing by publishing the notice in one or more newspapers of general
circulation within the area affected by the requested variance.

2. The notice must be published at least
once, not less than 10 days before the hearing and must specify the time, date
and place of the hearing, the nature of the application and the regulation
involved.

3. The Board will hold a public hearing on
the application 40 or more days after the date on which the Secretary receives
the application. The hearing will be held:

(a) At its next regularly scheduled meeting;

(b) At its next meeting in Carson City, Las Vegas
or Reno, as requested by the applicant in the application; or

NAC 439.230Procedure at hearing. (NRS 439.190, 439.200)The
following procedures apply to the hearing:

1. The staff of the Division of Public and
Behavioral Health of the Department of Health and Human Services shall submit
to the State Board of Health a report, including relevant data and a
recommendation, concerning the application. A copy of the report must be mailed
to the applicant at least 5 days before the hearing.

2. Members of the Board may ask relevant
questions of any person.

3. Any person with a demonstrated interest
in the application may present evidence but not testimony which is
argumentative or redundant.

4. The applicant has the burden of proof as
to the necessity for the variance.

5. At the conclusion of the hearing and
after consideration of all the evidence presented concerning the requested
variance, the Board will:

(a) Grant the variance;

(b) Deny the variance; or

(c) If further information is needed, continue the
hearing until such time as the information is obtained.

6. In granting a variance, the Board may
impose such conditions as it deems necessary or desirable.

7. Failure of the applicant to comply with
any of the conditions imposed by the Board constitutes grounds for immediate
revocation of the variance.

1. The State Board of Health will grant a
variance from a regulation only if it finds from the evidence presented at the
hearing that:

(a) There are circumstances or conditions which:

(1) Are unique to the applicant;

(2) Do not generally affect other persons
subject to the regulation;

(3) Make compliance with the regulation unduly
burdensome; and

(4) Cause a hardship to and abridge a
substantial property right of the applicant; and

(b) Granting the variance:

(1) Is necessary to render substantial justice
to the applicant and enable the applicant to preserve and enjoy his or her
property right; and

(2) Will not be detrimental or pose a danger
to public health and safety.

2. Whenever an applicant for a variance
alleges that he or she suffers or will suffer economic hardship by complying
with the regulation, the applicant must submit evidence demonstrating the costs
of compliance with the regulation. The Board will consider the evidence and
determine whether those costs are unreasonable.

1. Within 14 days after the hearing, the
State Board of Health will provide the applicant with a written decision
concerning the variance.

2. The decision will contain the Board’s
findings of fact on the matters described in NAC
439.240 and, if the variance is granted, will specify any conditions
imposed by the Board and, in a case where appropriate, the date on which the
variance expires.

1. An application to a district board of
health for a variance must be:

(a) Submitted in writing to the district health
officer.

(b) Accompanied by payment in full of the cost of
publication of notice of the application and the date of the public hearing on
it. The district health officer may waive the requirement that the applicant
pay the cost of publication upon a showing of extreme economic hardship.

2. The district health officer shall have
notice of the application and the date of the public hearing on it published in
a newspaper of general circulation within the health district.

3. The notice must be published at least
once, not less than 14 days before the hearing, and must specify the time, date
and place of the hearing, the nature of the application and the regulation
involved.

4. The district board of health or a hearing
board designated by it shall hold a public hearing on the application at the
next regularly scheduled meeting which is 40 or more days after the district
health officer receives the application, or as soon thereafter as the schedule
of the district board or hearing board permits.

5. If a hearing board designated by the
district board conducts the hearing, the hearing board acts in an advisory
capacity only and shall make a recommendation concerning the variance,
including findings of fact and any conditions which should be imposed, to the
district board not later than 10 days after the hearing. The district board
shall consider the recommendation at its next regularly scheduled meeting, or
as soon thereafter as its schedule permits, and may affirm the recommendation,
reject the recommendation or refer the recommendation back to the hearing board
for further consideration.

6. The district board or hearing board shall
comply with the applicable procedures for public hearings set forth in NAC 439.230, 439.240 and 439.250 and the criteria for granting variances in NAC 439.240.

7. The record of the district board’s
hearing on an application for a variance must include:

(a) The application;

(b) Proof of publication of notice concerning the
public hearing on the application;

(c) All documentary evidence submitted and
testimony heard;

(d) Written findings of fact;

(e) The decision; and

(f) If applicable, a statement of any condition
imposed by the board in granting the variance.

8. The record may be entirely in writing or
may be written in part and electronically recorded in part.

9. Within 10 days after the date of a
decision by the district board of health on an application for a variance, the
district health officer shall notify the Division of Public and Behavioral
Health of the Department of Health and Human Services of that decision.

1. Any person who is aggrieved by a decision
of a district board of health on an application for a variance from a
regulation of the State Board of Health may appeal in writing to the State
Board of Health within 30 days after the date of the decision, but the State
Board will not review the decision of a district board concerning any
regulation adopted by the district board.

2. Upon receipt of the appeal, the Secretary
of the State Board shall request a copy of the district board’s record of its
hearing on the application.

3. The district health officer shall forward
the record to the Secretary within 14 days after receipt of the request.

4. The State Board of Health will hold a
public hearing on the appeal not later than 40 days after the date on which the
Secretary of the Board receives the written appeal. The hearing will be held:

(a) At its next regularly scheduled meeting;

(b) At its next meeting in Carson City, Las Vegas
or Reno, as requested by the applicant in the application; or

(c) As soon thereafter as the schedule of the Board
permits.

5. At the hearing the State Board will limit
its consideration of evidence to the evidence contained in the record of the
district board’s hearing and will affirm or reverse the decision of the
district board or refer the application back to the district board for its
further consideration.

6. The State Board of Health will render a
written decision on an appeal within 14 days after the date of the hearing on
the appeal.

1. The provisions of NAC
439.200 to 439.270, inclusive, do not preclude
a person who is temporarily unable to comply or unable to comply fully with a
regulation from negotiating a schedule for compliance.

2. A district health officer may postpone
the enforcement of a regulation of the State Board of Health enforced by the
district board and agree with such a person to a schedule for compliance with
the regulation. If the period needed by such a person to comply exceeds 30
days, the schedule must be submitted to the district board of health for
approval.

3. In those areas of the State which are not
in a health district, or in case of a regulation enforced exclusively by the
State Board of Health, the Chief Medical Officer may postpone the enforcement
of and agree to a schedule for compliance with the regulation. If the period
needed by such a person to comply exceeds 45 days, the schedule must be
submitted to the State Board of Health for approval.

NAC 439.300Definitions. (NRS 439.200)As used
in NAC 439.300 to 439.395,
inclusive, unless the context otherwise requires, the words and terms defined
in NAC 439.301 to 439.307,
inclusive, have the meanings ascribed to them in those sections.

2. The denial, suspension or revocation of a
license, permit, certificate, endorsement, approval, registration, charter,
designation or other similar grant of permission to operate that is issued to a
person, facility or governmental entity by the Division.

(Added to NAC by Bd. of Health by R037-97, eff. 10-30-97)

NAC 439.305“Division” defined. (NRS 439.200)“Division”
means the Division of Public and Behavioral Health of the Department of Health
and Human Services.

(Added to NAC by Bd. of Health by R037-97, eff. 10-30-97)

NAC 439.307“Hearing officer” defined. (NRS 439.200)“Hearing
officer” means a person appointed by the Administrator of the Division to
preside at a hearing conducted pursuant to NAC 439.300
to 439.395, inclusive.

1. All hearings concerning appeals of
proposed disciplinary actions by the Division are governed by the provisions of
NAC 439.300 to 439.395,
inclusive, unless the applicable practice or procedure is specifically provided
by law or another regulation of the Board.

2. In special cases, where good cause
appears, the hearing officer may allow deviation from these provisions if he or
she finds compliance with the provisions to be impractical or unnecessary.

NAC 439.320Construction. (NRS 439.200)The
provisions of NAC 439.300 to 439.395,
inclusive, will be liberally construed to secure just, speedy and economical
determination of all issues presented to the hearing officer.

NAC 439.330Severability. (NRS 439.200)The
provisions of NAC 439.300 to 439.395,
inclusive, are severable. If any provision of these regulations or any
application to any person, thing or circumstance is held invalid, the Board
intends that such invalidity not affect the remaining provisions or applications
to the extent that they can be given effect.

1. The Administrator
shall appoint three permanent employees of the Division to act as hearing
officers. The hearing officers shall perform their duties in addition to their
regularly assigned duties.

2. An employee appointed as a hearing
officer must be appointed for a term of 2 years.

3. The Administrator of the Division shall
rotate the assignment of appeals among the hearing officers. Upon receipt of a
request for an appeal to be heard by a hearing officer, the Administrator shall
assign the appeal to the next hearing officer in the rotation unless that
hearing officer has a conflict of interest or is otherwise disqualified from
hearing the appeal.

4. A hearing officer shall not hear requests
for variances from the requirements of a regulation.

5. The Administrator may revoke the
appointment or change the assignment of a hearing officer for good cause.

(Added to NAC by Bd. of Health by R037-97, eff. 10-30-97)

NAC 439.345Notice of proposed disciplinary action: Duties of Division;
contents and service of notice. (NRS 439.200)

1. Except as
otherwise provided by specific statute or regulation or in the case of an
emergency or a summary suspension, if the Division intends to take disciplinary
action, the Division shall notify the applicant for or holder of a license,
permit, certificate, endorsement, approval, registration, charter, designation
or other similar grant of permission to operate or other affected person of the
proposed disciplinary action, in writing, at least 11 business days before the
effective date of the disciplinary action. The notice must include, without
limitation:

(a) A citation of the statutory and regulatory
authority for the disciplinary action;

(b) The facts on which the disciplinary action is
based;

(c) A description of any circumstances that the
Division considered in taking the disciplinary action;

(d) Instructions for responding to the notice,
including, without limitation, a statement of the right to any internal
informal procedures for appeal, the right to a hearing, the period during which
a hearing must be requested and the consequences of waiving a hearing; and

(e) The effective date of the disciplinary action.

2. The Division shall serve the notice by
personal delivery to the applicant, holder or other affected person or by
mailing the notice by registered or certified mail to his or her last known
residential or business address.

1. A person who
wishes to file an appeal with a hearing officer contesting proposed
disciplinary action by the Division must first exhaust all internal informal
procedures for appeals.

2. A request for an appeal must be addressed
to the Administrator of the Division and must be received by the Administrator
not later than 10 business days after the date on which the appellant received
notice of the proposed disciplinary action pursuant to NAC
439.345. The request must specify:

(a) The disciplinary action to be contested;

(b) The name of the officer or employee of the
Division who proposed the disciplinary action; and

(c) The reasons that the appellant believes the
disciplinary action is incorrect.

(Added to NAC by Bd. of Health by R037-97, eff. 10-30-97)

NAC 439.347Notice of hearing of appeal: Duties of hearing officer; contents
of notice. (NRS
439.200)Upon
receipt of an appeal, the hearing officer assigned to hear the appeal must
provide notice of the hearing to the appellant. The notice must include:

1. The date, time, place and subject matter
of the hearing;

2. A citation of the statutory and
regulatory authority and jurisdiction pursuant to which the hearing is to be
held; and

3. A brief and concise statement of the
matters asserted.

(Added to NAC by Bd. of Health by R037-97, eff. 10-30-97)

NAC 439.348Stay of proposed disciplinary action pending appeal; exceptions. (NRS 439.200)Except
as otherwise provided in NAC 449.99908
or in the case of an emergency or a summary suspension, the effective date of
the disciplinary action is stayed upon receipt of an appeal until the hearing
officer renders a decision regarding the appeal.

(Added to NAC by Bd. of Health by R037-97, eff. 10-30-97)

NAC 439.350Representation by attorney: Entry of appearance; service on
attorney; withdrawal by attorney. (NRS 439.200)

1. A party is entitled to be represented by
counsel. Counsel for a party must enter an appearance by submitting written
notice of the representation to the Administrator of the Division.

2. Following the entry of an appearance by
an attorney for a party, all notices, pleadings and orders to be served
thereafter upon the party must be served upon his or her attorney, and such
service is for all purposes considered valid service upon the party
represented.

3. Any attorney of record wishing to
withdraw from a proceeding before a hearing officer shall, in writing,
immediately notify the hearing officer, the party whom he or she represented
and any other parties to the proceeding.

1. A pleading before the hearing officer
must be styled a “petition” or “response.”

2. The hearing officer may, when the
substantial rights of the parties are not involved, allow a pleading to be
amended or corrected or any omission in it to be supplied.

3. All pleadings will be liberally construed
to effect justice between the parties, and the hearing officer may, at every
stage of any proceeding, disregard errors or defects in the pleadings or
proceedings which do not affect the substantial rights of the parties.

2. Each written motion must set forth the
nature of the relief sought, the grounds for the relief and citations of
applicable authority.

3. A party desiring to oppose a motion may
serve and file a written response to the motion within 10 days after receiving
the motion.

4. The moving party may serve and file a
written reply within 5 days after a written response to the motion has been
served and filed.

5. A decision on a motion will be rendered
without oral argument unless the hearing officer requires an oral argument, and
in that event the hearing officer shall set a date and time for hearing the
argument.

1. The hearing officer shall call the
hearing to order, state the appearances of the parties and their respective
counsel and act upon any pending motions, stipulations and preliminary matters.

2. All testimony must be under oath
administered by the hearing officer. Unless otherwise indicated by the hearing
officer, the hearing must proceed in the following manner:

(a) Opening statement for Division;

(b) Opening statement for appellant;

(c) Presentation of Division’s case, followed by
cross-examination;

(d) Responsible presentation by appellant, followed
by cross-examination;

(e) Rebuttal testimony for Division;

(f) Rebuttal testimony for appellant;

(g) Surrebuttal testimony for Division;

(h) Closing argument for Division;

(i) Closing argument for appellant;

(j) Rebuttal closing argument for Division; and

(k) Submission of case to the hearing officer.

3. At the conclusion of the hearing, the
hearing officer shall take the case under submission and shall notify the
parties in writing of his or her findings of fact, conclusions of law and
decision in the matter.

NAC 439.378Hearings: Subpoena and examination of witnesses; admission of
evidence; continuances; decision of hearing officer; record of proceedings. (NRS 439.200)

1. All requests for an appeal must be
addressed to the Administrator of the Division.

2. Except as otherwise provided in this
subsection, hearings on appeals must be open to the public. Upon the motion of
a party, the hearing officer, in his or her discretion, may exclude from the
hearing room any witnesses in the matter not at the time under examination
except a party or parties to the proceeding or his or her counsel.

3. The hearing officer shall determine the
evidence upon the charges and specifications as set forth by the Division in
its letter of notice of violation describing the nature of the violation and
the action taken or to be taken, or as contained in other appropriate
documents, and must not consider any additional evidence beyond the scope of
the charges.

4. The technical rules of evidence do not
apply. All testimony and exhibits offered must be relevant and bear upon the
matter in contention. Any testimony or exhibits considered by the hearing
officer as not meeting this criterion may properly be excluded. The hearing
officer shall also consider the objection of either side to the introduction of
evidence, whether oral testimony or exhibit. Competence and relevance are the
primary test in ruling on such objections.

5. The hearing officer shall base his or her
decision on the weight of the evidence presented at the hearing. Findings of
fact, conclusions of law and decisions must be based on substantial evidence.

6. At the beginning of his or her testimony,
each witness who has not previously testified in the hearing shall be required
to state his or her name and business, employment or position.

7. Any letter, paper or object offered in
evidence must be properly authenticated and, if received, must be marked by the
hearing reporter with a distinguishing number or letter, such as “Division’s
Exhibit 1” or “Licensee’s Exhibit A.”

8. Testimony may be presented in statement
or question and answer form.

9. Good cause appearing, hearings may be
continued beyond the period originally scheduled or recessed until a future
date agreeable to the hearing officer and the parties.

10. Witnesses may be subpoenaed by either
party to the hearing and shall receive the fees and mileage allowed a witness
in a civil case.

11. A record of the proceedings must be kept
but need not be transcribed unless the decision is appealed or a transcript is
requested by an interested party, who shall bear the cost of transcription.

NAC 439.380Hearings: Failure of party to appear; stipulations; continuances;
official notice. (NRS 439.200)

1. If a party fails to appear at a hearing
scheduled by the hearing officer and no continuance has been granted, the
hearing officer may hear the evidence and proceed to consider the matter and
dispose of it on the basis of the evidence before the hearing officer. If the
subject matter of the hearing is proposed disciplinary action and the appellant
fails to appear at the hearing and fails to reply to the notice, the charges
specified in the proposed finding are presumed to be true.

2. With the approval of the hearing officer,
the parties may stipulate as to any fact at issue, either by a written
stipulation introduced in evidence as an exhibit or by oral statements shown
upon the record. Any such stipulation is binding upon all parties so
stipulating and may be regarded by the hearing officer as evidence at the
hearing.

3. The hearing officer may, before or during
a hearing, upon a proper showing, grant a continuance for submission of
additional proof or other reasonable purpose.

4. In addition to the facts mentioned in
subsection 5 of NRS 233B.123,
the hearing officer may take official notice of:

(a) Regulations, official reports and decisions and
orders of the Board or any other regulatory agency of the State of Nevada.

1. An order or decision with separately
stated findings of fact and conclusions of law will be rendered by the hearing
officer after the completion of the hearing.

2. A proceeding stands submitted for
decision by the hearing officer after the taking of evidence, the filing of
briefs or the presentation of such oral or written arguments as may have been
allowed by the hearing officer.

NAC 439.395Judicial review of decision made by hearing officer. (NRS 439.200)The
decision of a hearing officer made pursuant to the procedures set forth in NAC 439.300 to 439.395,
inclusive, is a final decision in a contested case. Any person aggrieved by
such a decision is entitled to judicial review of the decision pursuant to NRS 233B.130.

(Added to NAC by Bd. of Health by R037-97, eff. 10-30-97)

SERVICES PROVIDED BY NURSES OF THE Division of Public and
Behavioral Health

1. Except as otherwise provided in NAC 442.222 for services and supplies
concerning family planning, a community health nursing clinic established by
the Division of Public and Behavioral Health shall charge and collect fees for
the services and supplies provided to a client by a nurse of the Division in an
amount set forth in the sliding schedule of fees established by the Division
pursuant to this section.

2. The Division of Public and Behavioral
Health shall establish a sliding schedule of fees which is based on:

(a) A cost analysis of the services and supplies
provided by the community health nursing clinics; and

(b) A ratio between the annual gross income of a
household and the federally designated level signifying poverty for a household
of that size as determined by the United States Department of Health and Human
Services and published annually in the Federal Register.

3. The Division of Public and Behavioral
Health shall renew and, if necessary, revise the sliding schedule of fees
established pursuant to this section:

(a) According to generally accepted accounting
principles; and

(b) As needed, to account for modifications to:

(1) The community health nursing program; and

(2) The federally designated levels signifying
poverty.

4. The sliding schedule of fees established
pursuant to this section and any revisions to the sliding schedule of fees
become effective upon approval of the sliding schedule of fees by the State
Board of Health.

5. The Division of Public and Behavioral
Health shall make the sliding schedule of fees established pursuant to this
section available:

(a) On the Internet website of the Division and in
each community health nursing clinic; and

(b) To any person upon request.

6. If the annual gross income of the
household ofa
client who is not able to pay a fee for services or supplies provided by a
nurse of the Division of Public and Behavioral Health is less than the federally
designated level signifying poverty, the community health nursing clinic shallnot deny the services or
supplies to the client.

7. Except as otherwise provided in
subsection 6, a community health nursing clinic may deny services or supplies
to a client if the client has not paid a fee owed for services or supplies
previously provided to the client from such a clinic.

8. As used in this section, “household”
means an association of persons who live together as a single economic unit,
regardless of whether they are related.

SERVICES PERFORMED BY DIVISION OF PUBLIC AND BEHAVIORAL
HEALTH IN RESPONDING TO VEHICULAR ACCIDENTS

NAC 439.610Definitions. (NRS 439.200)As used
in NAC 439.610 to 439.622,
inclusive, unless the context otherwise requires, the words and terms defined
in NAC 439.612 to 439.620,
inclusive, have the meanings ascribed to them in those sections.

NAC 439.620“Law enforcement agency” defined.
(NRS 439.200)“Law
enforcement agency” means an agency, office or bureau, the primary duty of
which is to enforce the law.

(Added to NAC by Bd. of Health by R192-03, eff. 1-22-2004)

NAC 439.622Determination of adulteration of or public risk from certain
substances: Fee; alleviation of risk. (NRS 439.150, 439.200)

1. If a law enforcement agency requests the
services of the Division in responding to an accident involving a vehicle used
to transport or hold food, drugs or cosmetics in commerce or a vehicle used for
septic tank pumping purposes, the Division shall charge and collect an hourly
fee of $90 from the manufacturer, producer, jobber or seller of the food, drugs
or cosmetics or the owner of the vehicle used for septic tank pumping purposes
to determine whether, as a result of the accident:

(a) The food, drugs or cosmetics:

(1) Have been adulterated and must be
quarantined, condemned or destroyed; or

(2) Have not been adulterated and may be
provided to the public for use or consumption.

(b) The contents of the vehicle used for septic
tank pumping purposes constitute a risk to the health or safety of the public.
If the Division determines there is a risk to the health or safety of the
public, it must provide guidance to the law enforcement agency to alleviate
such risk.

2. The hourly fee set forth in subsection 1:

(a) Applies to a period beginning at the time the
law enforcement agency provides notice of the accident to the personnel of the
Division; and

(b) Includes only the time actually spent by the
personnel of the Division in response to the accident, including, without
limitation, travel to the site of the accident and any investigation related to
the accident.

(Added to NAC by Bd. of Health by R192-03, eff. 1-22-2004)

FEES FOR SERVICES PERFORMED BY ENGINEERS OR ENVIRONMENTAL
HEALTH SPECIALISTS

NAC 439.650Fee for collecting sample of water. (NRS 439.150, 439.200)When an
entity or person requests the services of the Division of Public and Behavioral
Health of the Department of Health and Human Services in collecting a sample of
water, the Division shall charge and collect a fee of $133 from the requester
for each visit to the site by an employee of the Division.

NAC 439.700Appointment of deputy attorney general to represent Division of
Public and Behavioral Health. (NRS 439.190, 439.200)The
Division of Public and Behavioral Health of the Department of Health and Human
Services may request, at least 10 days before a hearing, that the Attorney
General appoint a deputy attorney general, separate from the deputy attorney
general representing the State Board of Health, to represent the Division
before the Board.

NAC 439.751Definitions. (NRS 439.735)As used
in NAC 439.750 to 439.790,
inclusive, unless the context otherwise requires, the words and terms defined
in NAC 439.752 to 439.767,
inclusive, have the meanings ascribed to them in those sections.

NAC 439.752“Applicant” defined. (NRS 439.735)“Applicant”
means a person who applies to the Department to receive a subsidy for coverage
for prescription drugs and pharmaceutical services pursuant to NRS 439.755.

1. A private insurer with whom the
Department has entered into a contract pursuant to NRS 439.745 to make available, at a
reasonable cost, policies of health insurance that provide coverage to certain
persons with disabilities for prescription drugs and pharmaceutical services;
or

2. An entity with which the Department has
entered into a contract to manage pharmaceutical benefits, including, without
limitation, processing and paying claims for pharmaceutical benefits on behalf
of the Department.

NAC 439.757“Enrollee” defined. (NRS 439.735)“Enrollee”
means a person who the Department has determined is eligible to receive a
subsidy for coverage for prescription drugs and pharmaceutical services
pursuant to NRS 439.745.

NAC 439.765“Prescription drug plan” and “PDP” defined. (NRS 439.735)“Prescription
drug plan” or “PDP” means coverage for prescription drugs that is offered under
a policy, contract or plan which has been approved as specified in 42 C.F.R. §
423.272 and which is offered by a sponsor that has a contract with the Centers for
Medicare and Medicaid Services of the United States Department of Health and
Human Services that meets the contract requirements under Subpart K of Part 423
of Title 42 of the Code of Federal Regulations.

NAC 439.766“Subsidy” defined. (NRS 439.735)“Subsidy”
means the amount of money that the Department may pay to a contractor,
prescription drug plan or Medicare Advantage plan with prescription drug
coverage or to the State Plan for Medicaid on behalf of a person with a
disability who meets the criteria for receiving a subsidy set forth in NRS 439.745 for coverage for
prescription drugs and pharmaceutical services.

NAC 439.768Eligibility for traditional benefits. (NRS 439.735)Persons
with disabilities who are not eligible for Medicare Part D may be eligible for
traditional benefits under the Disability Prescription Program, based on the
availability of funding and contractual agreements with a pharmacy benefit
manager selected by the Department through a formal bidding process.

NAC 439.769Eligibility for coordination of benefits. (NRS 439.735)A person
with a disability who is eligible for Medicare Part D may be eligible for
assistance with out-of-pocket expenses for prescription drugs and
pharmaceutical services. The availability of such coverage is subject to the
availability of funding and legislative approval of state subsidies that are
intended to maximize federal benefits and, to the extent possible, minimize
out-of-pocket expenses for prescription drugs and pharmaceutical services. Eligibility
for such coverage is subject to requirements that are similar, but not
identical, to the requirements for the Traditional Disability Prescription
Program, including, without limitation, all the following requirements:

1. An applicant must be at least 18 years of
age but not more than 61 years of age.

2. An applicant must have a verifiable
disability.

3. An applicant must have an annual income
that is less than the amount set forth in NRS 439.745.

4. An applicant who is eligible for Medicare
Part D must enroll in Medicare Part D and a prescription drug plan or Medicare
Advantage plan with prescription drug coverage.

5. An applicant who is eligible for any
federal subsidy under Medicare Part D must apply for and use any such subsidy
before requesting such coverage through the Disability Prescription Program.

6. An applicant who is not eligible for full
Medicaid in this State must meet a 1-year residency requirement as set forth in
NRS 439.745.

7. An applicant who is enrolled in full
Medicaid in this State is not required to meet the 1-year residency requirement
for a subsidy approved by the Legislature. Depending upon the technical aspects
of the coordination of benefits, the Department may allow such an applicant to
receive such coverage without actually enrolling in the Disability Prescription
Program.

NAC 439.770Request for information. (NRS 439.735)Upon
request, the Department will provide information to an applicant relating to
the criteria for receiving a subsidy, including, without limitation, any
documentation that the Department may require the applicant to provide to the
Department to verify that the applicant is eligible to receive a subsidy.

1. In addition to meeting the criteria for
receiving a subsidy set forth in NRS
439.745, an applicant who wishes to receive a subsidy must file a properly
completed application for a subsidy with the Department during a period of open
enrollment.

3. The Department may require an applicant
to provide, with the application, proof of his or her:

(a) Disability by submitting:

(1) A copy of a disability determination
letter issued by a public agency or private organization, approved by the
Department, whose programs or services are based at least in part on
disability;

(2) Any other appropriate documentation
satisfactory to the Department, including, without limitation, the statement of
a physician; or

(3) Any combination of the proof required
pursuant to subparagraph (1) or (2);

(b) Income by submitting a copy of his or her
income tax returns, a copy of his or her Social Security Form SSA-1099, copies
of wage statements, copies of dividend statements or other appropriate
documentation satisfactory to the Department of any other sources of income received
by the applicant in the 12 months immediately preceding the date of the
application;

(c) Assets by submitting a copy of income tax
returns, copies of savings account statements, copies of stock certificates or
other appropriate documentation satisfactory to the Department; and

(d) Continuous residency in this State for at least
the 12 months immediately preceding the date of the application by submitting a
copy of utility bills, rental agreements or any other appropriate documentation
satisfactory to the Department.

4. Each applicant shall provide the
Department with his or her social security number.

5. Each applicant shall provide the
following information about his or her status regarding Medicare Part D:

(a) Each applicant must declare whether he or she
is eligible for and enrolled in Medicare Part D, whether in a PDP or MA-PD,
and, if so, must provide the name of the plan.

(b) Each applicant who is eligible for Medicare
Part D must avail himself or herself of that benefit and apply for any
applicable federal low-income subsidy before seeking additional assistance
through the Disability Prescription Program.

(c) If the applicant is not enrolled in Medicare
Part D because the applicant missed the period of open enrollment, such an
applicant must state the reason for missing the period of open enrollment.
Depending upon the circumstances, such an applicant may be considered for
temporary enrollment in the Traditional Disability Prescription Program. The
applicant must then enroll in Medicare Part D and a PDP or MA-PD at the next
available opportunity or the applicant will be terminated from the Disability
Prescription Program.

(d) By checking “Yes” or “No” in the appropriate
place, the applicant must decide whether to grant the Disability Prescription
Program the authority to act as his or her authorized representative and, as
such, to enroll the applicant in an appropriate PDP or MA-PD. Such authority
does not preclude the applicant from changing his or her PDP or MA-PD before
implementation of Medicare Part D on January 1, 2006, or during subsequent
periods of open enrollment if the applicant is not satisfied with the
assignment made by the Disability Prescription Program.

6. An application shall be deemed received
by the Department on the date that the completed application is received by the
Department.

7. An application shall be deemed properly
completed if the application:

(a) Is submitted on the form prescribed by the
Department and filled out completely;

(b) Includes the documentation described in
subsection 3, if such documentation is required by the Department; and

(c) Includes the social security number of the
applicant as required pursuant to subsection 4.

Ê The
Department will return any incomplete application to the applicant with a
designation that the application has not been processed by the Department.

8. If an applicant or enrollee requests a
waiver of the eligibility requirement regarding household income pursuant to
subsection 5 of NRS 439.745
because of an illness or disability or extreme financial hardship, the
applicant or enrollee must include with that request a written statement signed
by a licensed physician certifying the illness or disability or other
appropriate documentation that satisfies the Department that an extreme
financial hardship exists. The Department will consider each request for such a
waiver on a case-by-case basis.

NAC 439.772Notice of approval or denial of application; notice of name of
new enrollee. (NRS
439.735)

1. Within 45 days after receiving an
application for a subsidy, the Department will provide written notice to the
applicant of its approval or denial of the application.

2. If the application is approved, the
notice must state:

(a) The amount of the subsidy that the Department
will pay to a contractor, PDP or MA-PD, or to the State Plan for Medicaid on
behalf of the applicant;

(b) The amount of the annual household income on
which the eligibility was based; and

(c) If the applicant is deemed eligible but there
is insufficient money available from the amount allocated for subsidies by the
Department, that the applicant has been placed on a waiting list in the order
of priority described in NAC 439.773.

3. If the application is denied, the notice
must state:

(a) The reason for the denial;

(b) The procedure for requesting a hearing to
review the decision of the Department as set forth in NAC
439.779; and

(c) The procedures for a hearing before the
Department as set forth in NAC 439.779 to 439.787, inclusive.

4. Within 30 days after the Department
approves an application, the Department will provide the name of the new
enrollee whose application was approved to the contractor or any other entity
necessary to ensure appropriate coordination of benefits.

1. Except as otherwise provided in
subsections 2, 3 and 4, if there is insufficient money available for each
applicant from the amount allocated for subsidies by the Department, the
Department will rank the applicants whose applications are approved based on
their household income. The applicant with the lowest household income will
receive priority over the other applicants. If the household income of two
applicants is exactly the same amount, the applicant whose application was
received earlier by the Department will receive priority over the other
applicant.

2. If an applicant documents a medical
condition that will deteriorate rapidly if prescribed medications are not
taken, the applicant will receive priority over other applicants on the waiting
list, regardless of income level. If two applicants document such emergent
medical conditions, the applicant whose application was received earlier by the
Department will receive priority over the other applicant.

3. If the Department determines that an
applicant whose income exceeds the established limits has a qualifying
financial hardship, the applicant will be ranked on the priority list at his or
her adjusted income level, which is the applicant’s actual income minus medical
costs or the cost of another qualifying hardship.

4. If, at any time, the Department determines
that there is sufficient money available from the amount allocated for
subsidies by the Department for more applicants, the Department may grant a
subsidy to an applicant on the waiting list in the order of priority described
in this section. If the Department grants a subsidy pursuant to this
subsection, the Department will provide written notice to the applicant in the
manner set forth in NAC 439.772.

5. For the purposes of this section, an
applicant shall be deemed to have a qualifying hardship if the applicant
submits to the Department:

(a) Documentation satisfactory to the Department
that verifies that the monthly cost of prescription drugs, pharmaceutical
services or out-of-pocket medical expenses, or any combination thereof, for the
applicant’s household is causing a hardship; or

(b) Documentation satisfactory to the Department
that verifies any other hardship of the applicant that the Department determines
is a qualifying hardship.

2. Except as otherwise provided in
subsection 8 of NAC 439.771, an applicant is not
eligible for a subsidy if the household income of the applicant for the year in
which the applicant submits his or her application exceeds the maximum
household income set forth in NRS
439.745.

3. For the purposes of subsection 2, the
year in which the applicant submits the application:

(a) Is not tied to the calendar year or fiscal
year; and

(b) Begins with the month that the application is
submitted and carries forward through the succeeding 12 months.

1. An applicant or enrollee shall cooperate
with the Department in securing all information and documentation necessary to
determine or confirm the eligibility of the applicant or continued eligibility
of the enrollee to receive a subsidy. If the applicant or enrollee fails to
cooperate, the Department will deny the application or will deem the enrollee
ineligible to receive a subsidy.

2. An enrollee shall update the information
contained in the application filed with the Department pursuant to NAC 439.771 that relates to his or her eligibility to
receive a subsidy, including, without limitation, a change in his or her:

(a) Name;

(b) Address;

(c) Telephone number;

(d) Household income;

(e) Marital status;

(f) Eligibility for Medicare Part D;

(g) Enrollment in a PDP or MA-PD or the selection
of a different PDP or MA-PD;

(h) Eligibility for Medicaid; or

(i) Eligibility for supplemental security income,

Ê by notifying
the Department in writing within 20 days after the information becomes
available to him or her.

1. If the Department approves an application
for a subsidy, the enrollee remains eligible to receive the subsidy as long as
he or she continues to meet the criteria for receiving a subsidy set forth in
this chapter and chapter 439 of NRS.

2. The Department will review the
eligibility of each enrollee at least annually. In conducting this review, the
Department will compare the information it has received from the enrollee with
information concerning the enrollee that is maintained by other federal, state,
county and local agencies, as well as other organizations that administer
programs for low-income persons or persons with disabilities.

3. If the Department is unable to determine
the continuing eligibility of the enrollee in the manner set forth in
subsection 2, the Department may require the enrollee to provide additional
documentation, including, without limitation, a copy of the income tax returns
of the enrollee.

4. If the Department is unable to obtain the
additional documentation required pursuant to subsection 3, the Department will
deem the enrollee ineligible to receive a subsidy.

NAC 439.777Discontinuation of subsidy to enrollee: Request by enrollee;
ineligibility of enrollee; granting of subsidy to applicant on waiting list if
enrollee determined ineligible. (NRS 439.735)

1. If an enrollee who is receiving a subsidy
wishes to discontinue receiving the subsidy, the enrollee must submit a written
request to that effect to the Department and notify the contractor in writing.

2. If, based on information the Department
receives, the Department reasonably believes that an enrollee no longer meets
the criteria for receiving a subsidy because one of the circumstances set forth
in subsection 3 applies to the enrollee, the Department shall provide the
enrollee with notice as set forth in NAC 439.778
and an opportunity for a hearing.

3. The circumstances in which an enrollee no
longer meets the criteria for receiving a subsidy include, without limitation,
that:

(a) The enrollee is eligible for coverage for
prescription drugs and pharmaceutical services through Medicare Part D, but the
enrollee declines to enroll in that program or in a PDP or MA-PD, or the
enrollee declines to apply for any federal subsidy available to him or her, or
both;

(b) The enrollee is eligible for coverage for
prescription drugs and pharmaceutical services through Medicare Part D and
qualifies for a federal low-income subsidy as a “very low-income beneficiary”;

(c) The household income of the enrollee exceeds
the maximum household income set forth in NRS 439.745;

(d) The enrollee knowingly provided incorrect
information on the application that he or she filed with the Department
pursuant to NAC 439.771 and failed to correct the
information within a reasonable time as determined by the Department;

(e) The enrollee failed to maintain residency in
this State; or

(f) The enrollee failed to respond timely to a
request for verification of the income of the enrollee or of any other annual
eligibility requirement.

4. The Department will deem an enrollee to
be ineligible to receive a subsidy if the enrollee does not request a hearing
within 30 days after the date of the notice provided to the enrollee pursuant
to subsection 2.

5. If an enrollee no longer meets the
criteria for receiving a subsidy because one of the circumstances set forth in
subsection 3 applies to the enrollee, the Department will grant a subsidy to an
applicant on the waiting list, if any, in the order of priority described in NAC 439.773.

NAC 439.778Notice to enrollee of determination regarding ineligibility. (NRS 439.735)If the
Department determines that an enrollee no longer meets the criteria for
receiving a subsidy set forth in this chapter and chapter 439 of NRS, it will notify the
enrollee in writing that the enrollee is ineligible to receive a subsidy. The
notice must inform the enrollee:

1. Of the reason that the enrollee is
ineligible to receive a subsidy;

2. Of the procedures set forth in NAC 439.779 for requesting a hearing to review the
decision of the Department; and

3. Of any free or inexpensive legal services
available in the area and must provide telephone numbers of the organizations
providing those services.

1. An applicant or enrollee who is aggrieved
by a decision of the Department concerning a subsidy and who wishes to have a
hearing before the Department must file a written request for a hearing with
the Department within 30 days after the date of the notice of the decision from
the Department.

2. The Department will schedule a hearing
within 45 days after it receives the request for a hearing.

1. Benefits of an existing enrollee may be
continued pending the outcome of the hearing if the enrollee requests such
continuation within 10 days after the date of the decision by the Department.

2. The Department will deny a request for
continuation of benefits if the request for a hearing is also denied pursuant
to NAC 439.781.

3. If benefits are continued and the
decision of the hearing officer upholds the decision of the Department, the
Department may require the enrollee to reimburse the Department for benefits
paid on behalf of the enrollee.

1. The Department will deny a request for a
hearing received pursuant to NAC 439.779 if:

(a) The sole issue being contested is an issue that
may only be resolved by amending the provisions of NRS 439.705 to 439.795, inclusive;

(b) The sole issue being contested is that the
Department denied an application for a subsidy, discontinued paying a subsidy
or reduced the amount of a subsidy, if that action by the Department was based
only upon the limits of the money available from the amount allocated for
subsidies by the Department;

(c) The sole issue being contested is an issue that
relates to a determination of the coverage of a policy of health insurance
under which an enrollee is covered and the enrollee has failed to complete a
process for resolving disputes established by the contractor; or

(d) The request is not received by the Department
within the limit on time set forth in NAC 439.779.

2. If a person who filed a request for a
hearing wishes to have the hearing dismissed, the person must submit a written
request for the dismissal of the hearing, signed by him or her, to the hearing
officer before the date of the hearing. Upon receipt of the request for
dismissal, the hearing officer shall dismiss the hearing and notify the person
requesting the dismissal and the Department of the dismissal.

NAC 439.782Testimony under oath. (NRS 439.735)All
testimony to be considered in a hearing must be taken under oath. Except as
otherwise provided in NAC 439.784, before
testifying, a person must swear or affirm before the hearing officer to the
truthfulness of the testimony he or she is about to give in the hearing.

1. Except as otherwise provided in NAC 439.784, a hearing must be conducted in person by
a hearing officer.

2. An applicant or enrollee may represent
himself or herself or may, in writing, authorize a person to represent him or
her at the hearing, including, without limitation, an attorney.

3. Upon request, each party to the hearing
shall submit to the hearing officer before the hearing copies of any evidence
or exhibit that the party will present during the hearing. The provisions of
this subsection do not preclude:

(a) A party from presenting additional evidence
during the hearing; or

(b) An applicant or enrollee from presenting
additional evidence after the hearing if requested by the hearing officer.

1. The hearing officer may conduct the
hearing over the telephone if he or she determines it is in the best interest
of each party to the hearing to do so.

2. A hearing that is conducted over the
telephone must be conducted at the office of a state agency or another location
approved by the hearing officer in advance of the hearing, at which a
representative of the Department will:

(a) Be available to answer the telephone call the
hearing officer places to begin the hearing;

(b) Administer the oath required pursuant to NAC 439.782 to the applicant or enrollee; and

(c) Receive any additional evidence that the
applicant or enrollee wishes to submit and transmit it to the hearing officer
by facsimile machine.

3. As used in this section, “facsimile
machine” means a device that sends or receives a reproduction or facsimile of a
document or photograph which is transmitted electronically or telephonically by
telecommunications lines.

1. The Department will produce a record of
the hearing and retain it for 3 years after the date the decision of the
hearing officer is issued or until the resolution of any judicial review of the
decision, whichever occurs later.

2. As used in this section, “record of the
hearing” means:

(a) All the documents filed with the Department
concerning the hearing;

(b) The official recording of the hearing or a
summary of the hearing prepared by a person designated by the Director of the
Department;

(c) All the evidence presented at the hearing and,
if requested by the hearing officer pursuant to NAC
439.783, after the hearing; and

1. The hearing officer presiding over a
hearing conducted pursuant to NAC 439.779 to 439.787, inclusive, shall cause the hearing to be
recorded on audiotape or any other means of sound reproduction. The Department
will consider that recording to be the official recording of the hearing.

2. A person may obtain a copy of the
official recording of a hearing in which the person was a party if he or she
submits to the Department:

(a) A written request; and

(b) The fee charged by the Department for an
official recording.

3. The fee for the official recording must
not be more than the actual cost to the Department of the audiotape or other
medium of sound reproduction used to record the hearing, plus the cost of
shipping and handling if applicable.

1. The decision of a hearing officer must be
in writing and be based exclusively on evidence presented at the hearing or, if
requested by the hearing officer pursuant to NAC
439.783, after the hearing.

2. Within 30 days after the date of the
hearing, the Department will send the decision of the hearing officer by
certified mail to the applicant or enrollee and to his or her authorized
representative, if any.

NAC 439.788Duties of Department if decision of Department is overturned by
hearing officer. (NRS 439.735)

1. If a hearing officer overturns a decision
of the Department to deny a subsidy or a decision that an enrollee is
ineligible to receive a subsidy, the Department will:

(a) Reimburse the applicant or the enrollee for the
actual out-of-pocket expenses for prescription drugs or pharmaceutical services
incurred from the date that the applicant or the enrollee appealed the decision
of the Department to the date that the decision of the hearing officer was
issued;

(b) Pay the amount of the subsidy due a contractor
from the date that the applicant or the enrollee appealed the decision of the
Department to the date that the decision of the hearing officer was issued; and

(c) Reimburse the applicant or the enrollee, upon
receipt of proof of payment for any premium paid to a contractor for a policy
of health insurance from the date that the applicant or the enrollee appealed
the decision of the Department to the date that the decision of the hearing
officer was issued.

2. The provisions of this section apply
regardless of whether the Department appeals the decision of the hearing
officer.

NAC 439.789Recoupment of subsidy paid in error; request by enrollee for
waiver or reduction of amount required to be returned. (NRS 439.735)

1. Except as otherwise provided in
subsections 4 and 5, the Department will pursue all legal remedies for the
collection of debt, including, without limitation, those remedies set forth in chapter 353C of NRS, to recoup a
subsidy that was paid in error from the contractor or enrollee determined by
the Department to be responsible for the error, including, without limitation,
a subsidy that was paid:

(a) To a contractor who was not entitled to receive
payment of the subsidy;

(b) For an enrollee whose application for a subsidy
was submitted with fraudulent intent; or

(c) For an enrollee who was otherwise not qualified
to receive the subsidy.

2. The Department will deposit all money it
collects for a subsidy that was paid in error with the State Treasurer for
credit to the Fund for a Healthy Nevada.

3. The Department may offset any amount due
the Department from a contractor because the contractor was not entitled to
receive payment of a subsidy or was paid an amount in excess of that which he
or she was entitled to receive for payment of a subsidy against any amount
owing to that contractor by the Department for the payment of any subsidy.

4. The provisions of paragraph (c) of
subsection 1 do not apply if the amount of the subsidy that was paid is $100 or
less.

5. Except as otherwise provided in this
subsection, if the Department determines that an enrollee has received a
subsidy in an amount that is in excess of the amount which he or she was
entitled to receive, the Department will recoup the amount in excess from the
enrollee in accordance with this section. An enrollee may request a waiver or
reduction of the amount in excess which he or she is required to return to the
Department based on hardship. Such a request must be submitted in writing to
the Department. The Department will consider each request for such a waiver or
reduction on a case-by-case basis. The Department will not consider a request
for such a waiver or reduction if the application for a subsidy which resulted
in an amount in excess being received by the enrollee was submitted with
fraudulent intent.

NAC 439.790Confidentiality of records. (NRS 439.735)The
records of the Department relating to an applicant or enrollee are confidential
and are considered protected health information under the Health Insurance
Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA). Any use
or release of protected health information must comply with the HIPAA
Privacy Manual established by the Department, which reflects the provisions
of Part 164 of Title 45 of the Code of Federal Regulations.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; A by Dep’t of Health & Human
Services by R157-05, 11-17-2005)

NAC 439.802Definitions. (NRS 439.655)As used
in NAC 439.800 to 439.862,
inclusive, unless the context otherwise requires, the words and terms defined
in NAC 439.804 to 439.8225,
inclusive, have the meanings ascribed to them in those sections.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; A by Dep’t of Health & Human
Services by R157-05, 11-17-2005)

NAC 439.804“Applicant” defined. (NRS 439.655)“Applicant”
means a person who applies to the Department to receive a subsidy for coverage
for prescription drugs and pharmaceutical services pursuant to NRS 439.670.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004)

1. A private insurer with whom the
Department has entered into a contract pursuant to NRS 439.665 to make available, at a
reasonable cost, policies of health insurance that provide coverage to senior
citizens for prescription drugs and pharmaceutical services; or

2. An entity with which the Department has
entered into a contract to manage pharmaceutical benefits, including, without
limitation, processing and paying claims for pharmaceutical benefits on behalf
of the Department.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by Dep’t of Health & Human Services by R157-05, 11-17-2005)

NAC 439.807“Coordination of benefits” defined. (NRS 439.735)“Coordination
of benefits” means the coordination of the Senior Prescription Program with
Medicare Part D in a manner that:

1. Maximizes coverage for prescription drugs
and pharmaceutical services for persons in this State;

2. Minimizes disruptions in the enrollment
of persons in this State in state and federal programs that provide coverage
for prescription drugs and pharmaceutical services;

3. Minimizes disruptions in the eligibility
of persons in this State for state and federal programs that provide coverage
for prescription drugs and pharmaceutical services;

4. Minimizes out-of-pocket expenses for
prescription drugs and pharmaceutical services for Medicare beneficiaries in
this State; and

5. Maximizes federal funding for coverage
for prescription drugs and pharmaceutical services for persons in this State.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by Dep’t of Health & Human Services by R157-05, 11-17-2005)

NAC 439.810“Enrollee” defined. (NRS 439.655)“Enrollee”
means a person who the Department has determined is eligible to receive a subsidy
for coverage for prescription drugs and pharmaceutical services pursuant to NRS 439.665.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004)

NAC 439.818“Open enrollment” defined. (NRS 439.655)“Open
enrollment” means a period prescribed by the Department during which an
application for a subsidy may be filed.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001)

NAC 439.819“Prescription drug plan” and “PDP” defined. (NRS 439.735)“Prescription
drug plan” or “PDP” means coverage for prescription drugs that is offered under
a policy, contract or plan which has been approved as specified in 42 C.F.R. §
423.272 and which is offered by a sponsor that has a contract with the Centers
for Medicare and Medicaid Services of the United States Department of Health
and Human Services that meets the contract requirements under Subpart K of Part
423 of Title 42 of the Code of Federal Regulations.

NAC 439.820“Senior citizen” defined. (NRS 439.655)“Senior
citizen” has the meaning ascribed to it in NRS 439.650.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001)

NAC 439.822“Subsidy” defined. (NRS 439.655)“Subsidy”
means the amount of money that the Department may pay to a contractor on behalf
of a senior citizen who meets the criteria for receiving a subsidy set forth in
NRS 439.665 for coverage for
prescription drugs and pharmaceutical services.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004)

NAC 439.8225“Traditional Senior Prescription Program” defined. (NRS 439.735)“Traditional
Senior Prescription Program” means the prescription drug benefits available to
eligible applicants who are not also eligible for Medicare Part D.

NAC 439.823Eligibility for traditional benefits. (NRS 439.735)Senior
citizens who are not eligible for Medicare Part D may be eligible for
traditional benefits under the Senior Prescription Program, based on the
availability of funding and contractual agreements with a pharmacy benefit
manager selected by the Department through a formal bidding process.

NAC 439.8235Eligibility for coordination of benefits. (NRS 439.735)A senior
citizen who is eligible for Medicare Part D may be eligible for assistance with
out-of-pocket expenses for prescription drugs and pharmaceutical services. The
availability of such coverage is subject to the availability of funding and
legislative approval of state subsidies that are intended to maximize federal
benefits and, to the extent possible, minimize out-of-pocket expenses for
prescription drugs and pharmaceutical services. Eligibility for such coverage
is subject to requirements that are similar, but not identical, to the
requirements for the Traditional Senior Prescription Program, including,
without limitation, all the following requirements:

1. An applicant must be 62 years of age or
older.

2. An applicant must have an annual income
that is less than the amount set forth in NRS 439.665.

3. An applicant who is eligible for Medicare
Part D must enroll in Medicare Part D and a prescription drug plan or Medicare
Advantage plan with prescription drug coverage.

4. An applicant who is eligible for any
federal subsidy under Medicare Part D must apply for and use any such subsidy
before requesting such coverage through the Senior Prescription Program.

5. An applicant who is not eligible for full
Medicaid in this State must meet a 1-year residency requirement as set forth in
NRS 439.665.

6. An applicant who is enrolled in full
Medicaid in this State is not required to meet the 1-year residency requirement
for a subsidy approved by the Legislature. Depending upon the technical aspects
of the coordination of benefits, the Department may allow such an applicant to
receive such coverage without actually enrolling in the Senior Prescription
Program.

NAC 439.824Request for information. (NRS 439.655)Upon
request, the Department will provide information to an applicant relating to
the criteria for receiving a subsidy, including, without limitation, any
documentation that the Department may require the applicant to provide to the
Department to verify that the applicant is eligible to receive a subsidy.

1. In addition to meeting the criteria for
receiving a subsidy set forth in NRS
439.665, an applicant who wishes to receive a subsidy must file a properly
completed application for a subsidy with the Department during a period of open
enrollment.

3. The Department may require an applicant
to provide, with the application, proof of his or her:

(a) Age by submitting a copy of his or her birth
certificate, driver’s license, social security letter, Medicare card, military
discharge papers or other appropriate document satisfactory to the Department;

(b) Income by submitting a copy of his or her
income tax returns, a copy of his or her Social Security Form SSA-1099, copies
of wage statements, copies of dividend statements or other appropriate
documentation satisfactory to the Department of any other sources of income
received by the applicant in the 12 months immediately preceding the date of
the application;

(c) Assets by submitting a copy of income tax
returns, copies of savings account statements, copies of stock certificates or
other appropriate documentation satisfactory to the Department; and

(d) Continuous residency in this State for at least
the 12 months immediately preceding the date of the application by submitting a
copy of utility bills, rental agreements or any other appropriate documentation
satisfactory to the Department.

4. Each applicant shall provide the
Department with his or her social security number.

5. Each applicant shall provide the
following information about his or her status regarding Medicare Part D:

(a) Each applicant must declare whether he or she
is eligible for and enrolled in Medicare Part D, whether in a PDP or MA-PD,
and, if so, must provide the name of the plan.

(b) Each applicant who is eligible for Medicare
Part D must avail himself or herself of that benefit and apply for any
applicable federal low-income subsidy before seeking additional assistance
through the Senior Prescription Program.

(c) If the applicant is not enrolled in Medicare
Part D because the applicant missed the period of open enrollment, the
applicant must state the reason for missing the period of open enrollment.
Depending upon the circumstances, such an applicant may be considered for
temporary enrollment in the Traditional Senior Prescription Program. The
applicant must then enroll in Medicare Part D and a PDP or MA-PD at the next
available opportunity or the applicant will be terminated from the Senior
Prescription Program.

(d) By checking “Yes” or “No” in the appropriate
place, the applicant must decide whether to grant the Senior Prescription
Program the authority to act as his or her authorized representative and, as
such, to enroll the applicant in an appropriate PDP or MA-PD. Such authority
does not preclude the applicant from changing his or her PDP or MA-PD before
implementation of Medicare Part D on January 1, 2006, or during subsequent
periods of open enrollment if the applicant is not satisfied with the
assignment made by the Senior Prescription Program.

6. Each year in which there is money
available from the amount allocated for subsidies by the Department, the
Department will designate at least one period of open enrollment.

7. An application shall be deemed received
by the Department on the date that the completed application is received by the
Department.

8. An application shall be deemed properly
completed if the application:

(a) Is submitted on the form prescribed by the
Department and filled out completely;

(b) Includes the documentation described in
subsection 3, if such documentation is required by the Department; and

(c) Includes the social security number of the
applicant as required pursuant to subsection 4.

Ê The Department
will return any incomplete application to the applicant with a designation that
the application has not been processed by the Department.

9. If an applicant or enrollee requests a
waiver of the eligibility requirement regarding household income pursuant to
subsection 5 of NRS 439.665
because of an illness or disability or extreme financial hardship, the
applicant or enrollee must include with that request a written statement signed
by a licensed physician certifying the illness or disability or other
appropriate documentation that satisfies the Department that an extreme
financial hardship exists. The Department will consider each request for such a
waiver on a case-by-case basis.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004; A by Dep’t of
Health & Human Services by R157-05, 11-17-2005)

NAC 439.828Notice of approval or denial of application; notice of name of
new enrollee. (NRS
439.735)

1. Within 45 days after receiving an
application for a subsidy, the Department will provide written notice to the
applicant of its approval or denial of the application.

2. If the application is approved, the
notice must state:

(a) The amount of the subsidy that the Department
will pay to a contractor, PDP or MA-PD, or to the State Plan for Medicaid on
behalf of the applicant;

(b) The amount of the annual household income on
which the eligibility was based; and

(c) If the applicant is deemed eligible but there
is insufficient money available from the amount allocated for subsidies by the
Department, that the applicant has been placed on a waiting list in the order
of priority described in NAC 439.830.

3. If the application is denied, the notice
must state:

(a) The reason for the denial;

(b) The procedure for requesting a hearing to
review the decision of the Department as set forth in NAC
439.842; and

(c) The procedures for a hearing before the
Department as set forth in NAC 439.842 to 439.856, inclusive.

4. Within 30 days after the Department
approves an application, the Department will provide the name of the new
enrollee whose application was approved to the contractor or any other entity
necessary to ensure appropriate coordination of benefits.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004; A by Dep’t of
Health & Human Services by R157-05, 11-17-2005)

1. Except as otherwise provided in
subsections 2, 3 and 4, if there is insufficient money available for each
applicant from the amount allocated for subsidies by the Department, the
Department will rank the applicants whose applications are approved based on
their household income. The applicant with the lowest household income will
receive priority over the other applicants. If the household income of two
applicants is exactly the same amount, the applicant whose application was
received earlier by the Department will receive priority over the other
applicant.

2. If an applicant documents a medical
condition that will deteriorate rapidly if prescribed medications are not
taken, the applicant will receive priority over other applicants on the waiting
list, regardless of income level. If two applicants document such emergent
medical conditions, the applicant whose application was received earlier by the
Department will receive priority over the other applicant.

3. If the Department determines that an
applicant whose income exceeds the established limits has a qualifying
financial hardship, the applicant will be ranked on the priority list at his or
her adjusted income level, which is the applicant’s actual income minus medical
costs or the cost of another qualifying hardship.

4. If the Department determines that an
applicant has a qualifying hardship, the applicant will receive priority over
the other applicants. If two or more applicants have qualifying hardships, the
Department will determine the order of priority as between each of those
applicants based on the needs of each applicant.

5. If, at any time, the Department
determines that there is sufficient money available from the amount allocated
for subsidies by the Department for more applicants, the Department may grant a
subsidy to an applicant on the waiting list in the order of priority described
in this section. If the Department grants a subsidy pursuant to this
subsection, the Department will provide written notice to the applicant in the
manner set forth in NAC 439.828.

6. For the purposes of this section, an
applicant shall be deemed to have a qualifying hardship if the applicant
submits to the Department:

(a) Documentation satisfactory to the Department
that verifies that the monthly cost of prescription drugs, pharmaceutical
services or out-of-pocket medical expenses, or any combination thereof, for the
applicant’s household is causing a hardship;

(b) A written statement signed by a licensed
physician certifying that, because of the applicant’s need for a prescription
drug or pharmaceutical service, the failure of the applicant to take the
prescription drug will place the life of the applicant in imminent danger; or

(c) Documentation satisfactory to the Department
that verifies any other hardship of the applicant that the Department
determines is a qualifying hardship.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004; A by Dep’t of
Health & Human Services by R157-05, 11-17-2005)

2. Except as otherwise provided in
subsection 9 of NAC 439.826, an applicant is not
eligible for a subsidy if the household income of the applicant for the year in
which the applicant submits his or her application exceeds the maximum
household income set forth in NRS
439.665.

3. For the purposes of subsection 2, the
year in which the applicant submits the application:

(a) Is not tied to the calendar year or fiscal
year; and

(b) Begins with the month that the application is
submitted and carries forward through the succeeding 12 months.

(Added to NAC by Dep’t of Human Resources by R143-01,
eff. 12-17-2001; A by R200-03, 9-17-2004; A by Dep’t of Health & Human
Services by R157-05, 11-17-2005)

1. An applicant or enrollee shall cooperate
with the Department in securing all information and documentation necessary to
determine or confirm the eligibility of the applicant or continued eligibility
of the enrollee to receive a subsidy. If the applicant or enrollee fails to
cooperate, the Department will deny the application or will deem the enrollee
ineligible to receive a subsidy.

2. An enrollee shall update the information
contained in the application filed with the Department pursuant to NAC 439.826 that relates to his or her eligibility to
receive a subsidy, including, without limitation, a change in his or her:

(a) Name;

(b) Address;

(c) Telephone number;

(d) Household income;

(e) Marital status;

(f) Eligibility for Medicare Part D;

(g) Enrollment in a PDP or MA-PD or selection of a
different PDP or MA-PD;

(h) Eligibility for Medicaid; or

(i) Eligibility for supplemental security income,

Ê by notifying
the Department in writing within 20 days after the information becomes
available to him or her.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R200-03, 9-17-2004; A by Dep’t of Health & Human
Services by R157-05, 11-17-2005)

1. If the Department approves an application
for a subsidy, the enrollee remains eligible to receive the subsidy as long as
he or she continues to meet the criteria for receiving a subsidy set forth in
this chapter and chapter 439 of NRS.

2. The Department will review the
eligibility of each enrollee at least annually. In conducting this review, the
Department will compare the information it has received from the enrollee with
information concerning the enrollee that is maintained by other federal, state,
county and local agencies, as well as other organizations that administer
programs for low-income persons or persons with disabilities.

3. If the Department is unable to determine
the continuing eligibility of the enrollee in the manner set forth in
subsection 2, the Department may require the enrollee to provide additional
documentation, including, without limitation, a copy of the income tax returns
of the enrollee.

4. If the Department is unable to obtain the
additional documentation required pursuant to subsection 3, the Department will
deem the enrollee ineligible to receive a subsidy.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R200-03, 9-17-2004; A by Dep’t of Health & Human
Services by R157-05, 11-17-2005)

NAC 439.838Discontinuation of subsidy to enrollee: Request by enrollee;
ineligibility of enrollee; granting of subsidy to applicant on waiting list if
enrollee determined ineligible. (NRS 439.735)

1. If an enrollee who is receiving a subsidy
wishes to discontinue receiving the subsidy, he or she must submit a written
request to that effect to the Department and notify the contractor in writing.

2. If, based on information the Department
receives, the Department reasonably believes that an enrollee no longer meets
the criteria for receiving a subsidy because one of the circumstances set forth
in subsection 3 applies to the enrollee, it shall provide the enrollee with
notice as set forth in NAC 439.840 and an
opportunity for a hearing.

3. The circumstances in which an enrollee no
longer meets the criteria for receiving a subsidy include, without limitation,
that:

(a) The enrollee is eligible for coverage for
prescription drugs and pharmaceutical services through Medicare Part D, but the
enrollee declines to enroll in that program or in a PDP or MA-PD, or the
enrollee declines to apply for any federal subsidy available to him or her, or
both;

(b) The enrollee is eligible for coverage for
prescription drugs and pharmaceutical services through Medicare Part D and
qualifies for a federal low-income subsidy as a “very low-income beneficiary”;

(c) The enrollee is eligible for coverage for
prescription drugs and pharmaceutical services through Medicaid;

(d) The household income of the enrollee exceeds
the maximum household income set forth in NRS 439.665;

(e) The enrollee knowingly provided incorrect
information on the application that he or she filed with the Department
pursuant to NAC 439.826 and failed to correct the
information within a reasonable time as determined by the Department;

(f) The enrollee failed to maintain residency in
this State; or

(g) The enrollee failed to respond timely to a
request for verification of the income of the applicant or of any other annual
eligibility requirement.

4. The Department will deem an enrollee to
be ineligible to receive a subsidy if the enrollee does not request a hearing
within 30 days after the date of the notice provided to the enrollee pursuant
to subsection 2.

5. If an enrollee no longer meets the
criteria for receiving a subsidy because one of the circumstances set forth in
subsection 3 applies to the enrollee, the Department will grant a subsidy to an
applicant on the waiting list, if any, in the order of priority described in NAC 439.830.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004; A by Dep’t of
Health & Human Services by R157-05, 11-17-2005)

NAC 439.840Notice to enrollee of determination regarding ineligibility. (NRS 439.655)If the
Department determines that an enrollee no longer meets the criteria for
receiving a subsidy set forth in this chapter and chapter 439 of NRS, it will notify the
enrollee in writing that the enrollee is ineligible to receive a subsidy. The
notice must inform the enrollee:

1. Of the reason that the enrollee is
ineligible to receive a subsidy;

2. Of the procedures set forth in NAC 439.842 for requesting a hearing to review the
decision of the Department; and

3. Of any free or inexpensive legal services
available in the area and must provide telephone numbers of the organizations
providing those services.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004; A by Dep’t of
Health & Human Services by R157-05, 11-17-2005)

1. An applicant or enrollee who is aggrieved
by a decision of the Department concerning a subsidy and who wishes to have a
hearing before the Department must file a written request for a hearing with
the Department within 30 days after the date of the notice of the decision from
the Department.

2. The Department will schedule a hearing
within 45 days after it receives the request for a hearing.

1. Benefits of an existing enrollee may be
continued pending the outcome of the hearing if the enrollee requests such
continuation within 10 days after the date of the decision by the Department.

2. The Department will deny a request for
continuation of benefits if the request for a hearing is also denied pursuant
to NAC 439.844.

3. If benefits are continued and the decision
of the hearing officer upholds the decision of the Department, the Department
may require the enrollee to reimburse the Department for benefits paid on
behalf of the enrollee.

1. The Department will deny a request for a
hearing received pursuant to NAC 439.842 if:

(a) The sole issue being contested is an issue that
may only be resolved by amending the provisions of NRS 439.635 to 439.690, inclusive;

(b) The sole issue being contested is that the
Department denied an application for a subsidy, discontinued paying a subsidy
or reduced the amount of a subsidy, if that action by the Department was based
only upon the limits of the money available from the amount allocated for
subsidies by the Department;

(c) The sole issue being contested is an issue that
relates to a determination of the coverage of a policy of health insurance under
which an enrollee is covered and the enrollee has failed to complete a process
for resolving disputes established by the contractor; or

(d) The request is not received by the Department
within the limit on time set forth in NAC 439.842.

2. If a person who filed a request for a
hearing wishes to have the hearing dismissed, the person must submit a written
request for the dismissal of the hearing, signed by him or her, to the hearing
officer before the date of the hearing. Upon receipt of the request for
dismissal, the hearing officer shall dismiss the hearing and notify the person
requesting the dismissal and the Department of the dismissal.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004)

NAC 439.846Testimony under oath. (NRS 439.655)All
testimony to be considered in a hearing must be taken under oath. Except as
otherwise provided in NAC 439.850, before
testifying, a person must swear or affirm before the hearing officer to the
truthfulness of the testimony he or she is about to give in the hearing.

1. Except as otherwise provided in NAC 439.850, a hearing must be conducted in person by
a hearing officer.

2. An applicant or enrollee may represent
himself or herself or may, in writing, authorize a person to represent him or
her at the hearing, including, without limitation, an attorney.

3. Upon request, each party to the hearing
shall submit to the hearing officer before the hearing copies of any evidence
or exhibit that the party will present during the hearing. The provisions of
this subsection do not preclude:

(a) A party from presenting additional evidence
during the hearing; or

(b) An applicant or enrollee from presenting
additional evidence after the hearing if requested by the hearing officer.

1. The hearing officer may conduct the
hearing over the telephone if he or she determines it is in the best interest
of each party to the hearing to do so.

2. A hearing that is conducted over the
telephone must be conducted at the office of a state agency or another location
approved by the hearing officer in advance of the hearing, at which a
representative of the Department will:

(a) Be available to answer the telephone call the
hearing officer places to begin the hearing;

(b) Administer the oath required pursuant to NAC 439.846 to the applicant or enrollee; and

(c) Receive any additional evidence that the
applicant or enrollee wishes to submit and transmit it to the hearing officer
by facsimile machine.

3. As used in this section, “facsimile
machine” means a device that sends or receives a reproduction or facsimile of a
document or photograph which is transmitted electronically or telephonically by
telecommunications lines.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001)

1. The Department will produce a record of
the hearing and retain it for 3 years after the date the decision of the
hearing officer is issued or until the resolution of any judicial review of the
decision, whichever occurs later.

2. As used in this section, “record of the
hearing” means:

(a) All the documents filed with the Department
concerning the hearing;

(b) The official recording of the hearing or a
summary of the hearing prepared by a person designated by the Director of the
Department;

(c) All the evidence presented at the hearing and,
if requested by the hearing officer pursuant to NAC
439.848, after the hearing; and

1. The hearing officer presiding over a
hearing conducted pursuant to NAC 439.842 to 439.856, inclusive, shall cause the hearing to be
recorded on audiotape or any other means of sound reproduction. The Department
will consider that recording to be the official recording of the hearing.

2. A person may obtain a copy of the
official recording of a hearing in which he or she was a party if the person
submits to the Department:

(a) A written request; and

(b) The fee charged by the Department for an
official recording.

3. The fee for the official recording must
not be more than the actual cost to the Department of the audiotape or other
medium of sound reproduction used to record the hearing, plus the cost of
shipping and handling if applicable.

1. The decision of a hearing officer must be
in writing and be based exclusively on evidence presented at the hearing or, if
requested by the hearing officer pursuant to NAC
439.848, after the hearing.

2. Within 30 days after the date of the
hearing, the Department will send the decision of the hearing officer by
certified mail to the applicant or enrollee and to his or her authorized
representative, if any.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001)

NAC 439.858Duties of Department if decision of Department is overturned by
hearing officer. (NRS 439.655)

1. If a hearing officer overturns a decision
of the Department to deny a subsidy or that an enrollee is ineligible to receive
a subsidy, the Department will:

(a) Reimburse the applicant or the enrollee for the
actual out-of-pocket expenses for prescription drugs or pharmaceutical services
incurred from the date that the applicant or the enrollee appealed the decision
of the Department to the date that the decision of the hearing officer was
issued;

(b) Pay the amount of the subsidy due to a
contractor from the date that the applicant or the enrollee appealed the
decision of the Department to the date that the decision of the hearing officer
was issued; and

(c) Reimburse the applicant or the enrollee, upon
receipt of proof of payment for any premium paid to a contractor for a policy
of health insurance from the date that the applicant or the enrollee appealed
the decision of the Department to the date that the decision of the hearing
officer was issued.

2. The provisions of this section apply
regardless of whether the Department appeals the decision of the hearing
officer.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004; A by Dep’t of
Health & Human Services by R157-05, 11-17-2005)

Miscellaneous Provisions

NAC 439.860Recoupment of subsidy paid in error; request by enrollee for
waiver or reduction of amount required to be returned. (NRS 439.655)

1. Except as otherwise provided in
subsections 4 and 5, the Department will pursue all legal remedies for the
collection of debt, including, without limitation, those remedies set forth in chapter 353C of NRS, to recoup a
subsidy that was paid in error from the contractor or enrollee determined by
the Department to be responsible for the error, including, without limitation,
a subsidy that was paid:

(a) To a contractor who was not entitled to receive
payment of the subsidy;

(b) For an enrollee whose application for a subsidy
was submitted with fraudulent intent; or

(c) For an enrollee who was otherwise not qualified
to receive the subsidy.

2. The Department will deposit all money it
collects for a subsidy that was paid in error with the State Treasurer for
credit to the Fund for a Healthy Nevada.

3. The Department may offset any amount due
the Department from a contractor because the contractor was not entitled to
receive payment of a subsidy or was paid an amount in excess of that which he
or she was entitled to receive for payment of a subsidy against any amount
owing to that contractor by the Department for the payment of any subsidy.

4. The provisions of paragraph (c) of
subsection 1 do not apply if the amount of the subsidy that was paid is $100 or
less.

5. Except as otherwise provided in this
subsection, if the Department determines that an enrollee has received a
subsidy in an amount that is in excess of the amount which he or she was
entitled to receive, the Department will recoup the amount in excess from the
enrollee in accordance with this section. An enrollee may request a waiver or
reduction of the amount in excess which he or she is required to return to the
Department based on hardship. Such a request must be submitted in writing to
the Department. The Department will consider each request for such a waiver or
reduction on a case-by-case basis. The Department will not consider a request
for such a waiver or reduction if the application for a subsidy which resulted
in an amount in excess being received by the enrollee was submitted with
fraudulent intent.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by R143-01, 12-17-2001; R200-03, 9-17-2004)

NAC 439.862Confidentiality of records. (NRS 439.655)The
records of the Department relating to an applicant or enrollee are confidential
and are considered protected health information under the Health Insurance
Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA). Any use
or release of protected health information must comply with the HIPAA
Privacy Manual established by the Department, which reflects the provisions
of Part 164 of Title 45 of the Code of Federal Regulations.

(Added to NAC by Dep’t of Human Resources by R069-00,
eff. 3-2-2001; A by Dep’t of Health & Human Services by R157-05, 11-17-2005)

NAC 439.875“Division” defined. (NRS 439.200, 439.265)“Division”
means the Division of Public and Behavioral Health of the Department.

(Added to NAC by Bd. of Health by R041-08, eff. 9-18-2008)

NAC 439.877“Provider” defined. (NRS 439.200, 439.265)“Provider”
means any person who is licensed, certified or otherwise authorized by the laws
of this State, or the regulations adopted pursuant thereto, to administer immunizations.

(Added to NAC by Bd. of Health by R041-08, eff. 9-18-2008)

NAC 439.880“System” defined. (NRS 439.200, 439.265)“System”
means the Immunization Information System established by the Department
pursuant to NRS 439.265.

(Added to NAC by Bd. of Health by R041-08, eff. 9-18-2008)

NAC 439.883Notice to parent or guardian by provider regarding System;
contents; notice to provider to opt out of System. (NRS 439.200, 439.265)

1. A provider administering an immunization
to a child shall provide notice about the System to the parent or guardian of
the child on a form provided by the Division. The notice must include:

(a) A description of the System;

(b) A description of the information concerning the
child which will be reported by the provider for inclusion in the System,
including, without limitation, the immunization record of the child and the
information required by NAC 439.890; and

(c) The procedure for a parent or guardian to
decline inclusion of the information concerning his or her child in the System.

2. The notice required by subsection 1 must
be provided upon the initial visit of a child to a provider for administration
of an immunization.

3. If a parent or guardian declines
inclusion of the information concerning his or her child in the System, the
parent or guardian is responsible for notifying the provider of his or her
decision to opt out of the System at each subsequent visit of the child to the
provider for an immunization.

(Added to NAC by Bd. of Health by R041-08, eff. 9-18-2008)

NAC 439.885Notice to adult by provider regarding System; contents; notice to
provider by adult to opt out of System. (NRS 439.200)

1. A provider administering an immunization
to an adult shall provide notice about the System to the adult on a form
provided by the Division. The notice must include:

(a) A description of the System;

(b) A description of the information concerning the
adult which will be reported by the provider for inclusion in the System,
including, without limitation, the immunization record of the adult and the
information set forth in NAC 439.893; and

(c) The procedure for an adult to decline inclusion
of his or her information in the System.

2. The notice required by subsection 1 must
be provided upon the initial visit of an adult to a provider for administration
of an immunization.

3. An adult may withdraw his or her
participation in the System at any time in accordance with the procedure
prescribed by the Division.

4. If an adult declines inclusion of his or
her information in the System, the adult is responsible for notifying the
provider of the decision to opt out of the System at each subsequent visit of
the adult to the provider for an immunization.

(Added to NAC by Bd. of Health by R041-08, eff. 9-18-2008;
A by R094-09, 1-28-2010)

NAC 439.887Inclusion of records in System for immunizations administered
before July 1, 2009; requests for removal of records from System. (NRS 439.200, 439.265)

1. Except as otherwise provided in
subsection 3, the Division shall include in the System all immunization records
in the possession of the Division for immunizations of children and adults
administered before July 1, 2009.

2. Except as otherwise provided in this
subsection and subsection 3, a provider may report to the System the records of
the immunizations administered to any child or adult before July 1, 2009, if
such information was not previously reported. A provider may report the
information concerning an adult unless the adult has declined inclusion of his
or her information in the System pursuant to NAC
439.885.

3. The Division shall develop and make
available to providers and the general public the form by which the parent or
guardian of a child or an adult may request the removal of the immunization
records included in the System pursuant to this section.

(Added to NAC by Bd. of Health by R041-08, eff. 9-18-2008;
A by R094-09, 1-28-2010)

1. In addition to the information required
by NRS 439.265, a provider who administers
an immunization to a child on or after July 1, 2009, shall report the following
information, if available, to the Department for inclusion in the System:

(a) The address of the child;

(b) The county in which the child resides;

(c) The child’s date of birth;

(d) The state and country in which the child was
born;

(e) The full name of the child’s mother;

(f) The manufacturer and lot number of the vaccine
administered to the child;

(g) The date on which the immunization was
administered to the child; and

(h) The information required pursuant to the Listing
of Core Data Items prescribed by the Centers for Disease Control and
Prevention of the United States Department of Health and Human Services. A copy
of the Listing of Core Data Items may be obtained, free of charge, from:

(1) The Centers for Disease Control and
Prevention at the Internet address http://www.cdc.gov/vaccines/programs/iis/stds/coredata.htm;
or

1. A provider who administers an
immunization to an adult on or after July 1, 2009, shall, unless the adult has
declined inclusion of his or her information in the System pursuant to NAC 439.885, report the following information, if
available, to the Department:

(a) The name and address of the person who received
the immunization;

(b) The county in which the person resides;

(c) The person’s date of birth;

(d) The state and country in which the person was
born;

(e) The person’s gender;

(f) The person’s race or ethnicity;

(g) The name, manufacturer and lot number of the
vaccine administered to the person;

(h) The date on which the immunization was
administered to the person; and

(i) The information required pursuant to the Listing
of Core Data Items prescribed by the Centers for Disease Control and
Prevention of the United States Department of Health and Human Services. A copy
of the Listing of Core Data Items may be obtained, free of charge, from:

(1) The Centers for Disease Control and
Prevention at the Internet address http://www.cdc.gov/vaccines/programs/iis/stds/coredata.htm;
or

2. The Division shall provide the form for
reporting the information required by subsection 1. A provider shall report the
information:

(a) Directly to the System; or

(b) If an undue hardship prevents the provider from
reporting the information directly to the System, using the form provided by
the Division.

(Added to NAC by Bd. of Health by R041-08, eff. 9-18-2008;
A by R094-09, 1-28-2010)

NAC 439.895Confidentiality and access. (NRS 439.200, 439.265)Except
as otherwise provided in NRS 439.265
or other specific statute, the information included in the System is
confidential and access must be limited to:

4. Public schools and private schools as
defined in NRS 385.007 and 394.103, respectively;

5. The Department;

6. An insurer as defined in NRS 679B.540, regardless of
whether the insurer directly covered the immunization;

7. An agency which provides child welfare
services as defined in NRS
432B.030; and

8. The Department of Corrections.

(Added to NAC by Bd. of Health by R041-08, eff. 9-18-2008)

NAC 439.897Official certificate of immunization. (NRS 439.200, 439.265)An
immunization record provided by the System shall be deemed an official
certificate of immunization, as required for enrollment in any school, college
or university and child care facility in this State.

(Added to NAC by Bd. of Health by R041-08, eff. 9-18-2008)

HEALTH AND SAFETY OF PATIENTS AT CERTAIN MEDICAL FACILITIES

NAC 439.900Definitions. (NRS 439.890)As used
in NAC 439.900 to 439.945,
inclusive, unless the context otherwise requires, the words and terms defined
in NAC 439.902 to 439.912,
inclusive, have the meanings ascribed to them in those sections.

(Added to NAC by Health Div. by R118-04, eff. 11-4-2004)

NAC 439.902“Division” defined. (NRS 439.890)“Division”
means the Division of Public and Behavioral Health of the Department of Health
and Human Services.

(Added to NAC by Health Div. by R118-04, eff. 11-4-2004;
A by Bd. of Health by R044-10, 10-15-2010)

NAC 439.903“Facility-acquired infection” defined. (NRS 439.890)“Facility-acquired
infection” has the meaning ascribed to it in NRS 439.802.

(Added to NAC by Bd. of Health by R044-10, eff. 10-15-2010)—(Substituted
in revision for NAC 439.901)

NAC 439.904“Medical facility” defined. (NRS 439.890)“Medical
facility” has the meaning ascribed to it in NRS 439.805.

(Added to NAC by Health Div. by R118-04, eff. 11-4-2004)

NAC 439.905“National Healthcare Safety Network” defined. (NRS 439.890)“National
Healthcare Safety Network” means the secure, Internet-based surveillance system
established by the Division of Healthcare Quality Promotion of the Centers for
Disease Control and Prevention of the United States Department of Health and
Human Services that integrates patient and health care personnel safety
surveillance systems.

1. A report submitted pursuant to NRS 439.835 must be submitted in
the format prescribed pursuant to subsection 4 and must include, without
limitation:

(a) The unique identification code assigned to the
medical facility by the Division pursuant to subsection 5;

(b) The name of the person who is making the
report;

(c) The date on which the sentinel event occurred;

(d) The date and time that the medical facility was
notified of the occurrence of the sentinel event;

(e) If the patient resides in this State, the
county in which the patient resides;

(f) If the patient does not reside in this State,
the state or country in which the patient resides;

(g) The date of birth of the patient;

(h) The gender of the patient;

(i) A description of the sentinel event; and

(j) The department of the medical facility at which
the sentinel event occurred.

2. Within 45 days after receiving
notification or becoming aware of the occurrence of a sentinel event pursuant
to subsection 1 or 2 of NRS 439.835,
the patient safety officer of the medical facility in which the sentinel event
occurred must submit a second report to the Division. A report required by this
subsection must be submitted in the format prescribed pursuant to subsection 4
and must include, without limitation:

(a) The factors that contributed to the sentinel
event, including, without limitation:

(1) Any medical or other condition of the
patient;

(2) Any policy, procedure or process of the
medical facility;

(3) Any environmental condition of the medical
facility;

(4) Any behavior of a member of the staff of
the medical facility;

(5) Any situation present at the medical
facility; and

(6) Any problem involving communication or
documentation at the medical facility.

(b) The corrective actions, if any, identified
pursuant to NAC 439.917 that will be taken by the
medical facility to address the factors that contributed to the sentinel event,
including, without limitation:

(1) A review of the policies, procedures or
processes of the medical facility;

(2) Any change or development of the policies,
procedures or processes of the medical facility;

(3) Any disciplinary actions taken against a
member of the staff of the medical facility by the medical facility;

(4) Any environmental or equipment changes
made in the medical facility;

(5) Any education or retraining provided to
the staff of the medical facility;

(6) The date by which each corrective action
will be completed; and

(7) The title of the person who is responsible
for overseeing each corrective action.

(c) A copy of the plan to remedy the causes or
contributing factors, or both, of the sentinel event developed pursuant to
subsection 3 of NAC 439.917 or the statement
prepared pursuant to subsection 4 of that section.

3. A report submitted pursuant to subsection
1 must indicate the date and time that the report was submitted to the
Division. Proof satisfactory to the Division of the date and time that a report
was submitted includes:

(a) The postmark on the package in which the report
was submitted to the Division;

(b) The time stamp created by a facsimile machine
used to transmit the report to the Division;

(c) The electronic time stamp created by a program
of electronic mail used to transmit the report to the Division; and

(d) Any other evidence acceptable to the Division,
as indicated on the form created by the Division pursuant to subsection 4.

4. The Division shall develop the format for
each report required by subsection 1 or 2, which must require, without
limitation, the reporting of information relating to events on the list of
serious reportable events contained in the most recent version of “Serious
Reportable Events in Healthcare,” issued by the National Quality Forum, which
is hereby adopted by reference. The Division shall distribute copies of the
forms created pursuant to this subsection to each medical facility in this
State. The Division shall notify medical facilities that an update to a form is
available within 30 days after making a change to a form.

5. The Division shall assign a unique
identification code to each medical facility in this State, to be used on the
reports required by subsections 1 and 2.

6. The most recent edition of “Serious
Reportable Events in Healthcare,” which is adopted by reference in subsection
4, may be obtained free of charge from the National Quality Forum, 601 13th
Street, N.W., Suite 500 North, Washington, D.C. 20005 or on the Internet at http://www.qualityforum.org/Publications.aspx.
If the State Board of Health determines that a revision is not suitable for
this State, the Board will:

(a) Hold a public hearing to review its
determination within 6 months after the date of the publication of the
revision; and

(b) Give notice of that hearing.

Ê If, after the
hearing, the Board does not revise its determination, the Board will give
notice within 30 days after the hearing that the revision is not suitable for
this State. If the Board does not give such notice, the revision becomes part
of the publication adopted by reference in subsection 4.

(Added to NAC by Health Div. by R118-04, eff. 11-4-2004;
A by Bd. of Health by R044-10, 10-15-2010)

NAC 439.916Reporting of sentinel event by a medical facility receiving a
patient who was transferred or discharged from another medical facility. (NRS 439.835, 439.890)

1. If a medical facility that receives a
patient who was transferred or discharged from another medical facility
believes that a sentinel event affecting the patient occurred at the other
medical facility, the medical facility that received the patient shall report
the sentinel event to the facility from which the patient was transferred or
discharged.

2. A medical facility that is informed of a
sentinel event pursuant to subsection 1 shall report the sentinel event
pursuant to NRS 439.835 and NAC 439.900 to 439.945,
inclusive.

1. Within 45 days after reporting a sentinel
event pursuant to NRS 439.835,
the medical facility shall conduct an investigation of the causes or
contributing factors, or both, of the sentinel event.

2. The investigation conducted pursuant to
this section must:

(a) Determine whether changes in the policies,
procedures or processes of the medical facility are necessary to prevent a
subsequent sentinel event under similar circumstances.

(b) Follow a nationally recognized methodology for
conducting an analysis of the root cause of the sentinel event, including,
without limitation, the methodology prescribed by:

(1) The Joint Commission; or

(2) The United States Department of Veterans
Affairs National Center for Patient Safety.

(c) Be provided to the Division upon request.

3. Except as otherwise provided in
subsection 4, a medical facility shall, after conducting an investigation
pursuant to this section, develop and implement a plan to remedy the causes or
contributing factors, or both, of the sentinel event. The plan must:

(a) State how each finding of the investigation
will be addressed and, if necessary, corrected by the medical facility;

(b) Identify the changes and corrective actions
that will be implemented by the medical facility to reduce risk to patients or
provide an explanation for not implementing any changes or corrective actions;

(c) Provide the title of the person responsible for
implementing each change and corrective action identified in the plan;

(d) Provide a timeline for implementing the plan,
including, without limitation, when each change or corrective action will be
implemented by the medical facility;

(e) Provide for an evaluation of the effectiveness
of the plan and a method for making revisions to the plan based on the
evaluation;

(f) Establish a schedule for monitoring and
assessing the continued effectiveness of the plan; and

(g) Provide the title of the person who is
responsible for monitoring the overall plan.

4. If, after conducting an investigation
pursuant to this section, a medical facility determines that a plan to remedy
the causes or contributing factors, or both, of the sentinel event is not
necessary, the medical facility shall prepare a written statement documenting
the reasons for making such a determination.

5. Except as otherwise provided in this
section and NRS 239.0115,
information provided to the Division relating to the plan developed pursuant to
subsection 3 or the statement prepared pursuant to subsection 4 and any
additional information requested by the Division is confidential, not subject
to subpoena or discovery and not subject to inspection by the general public.

1. A medical facility that has fewer than 25
employees and contractors shall establish a patient safety committee composed
of:

(a) The patient safety officer of the medical
facility;

(b) At least two providers of health care who treat
patients at the medical facility, including, without limitation, one member of
the medical staff and one member of the nursing staff of the medical facility;
and

(c) The chief executive officer or chief financial
officer of the medical facility.

2. A patient safety committee established
pursuant to this section must meet at least once every calendar quarter.

(Added to NAC by Health Div. by R118-04, eff. 11-4-2004)

NAC 439.925Participation in National Healthcare Safety Network: Calculation
of average patients per business day. (NRS 439.847, 439.890)For
purposes of subsection 1 of NRS
439.847, to determine whether a medical facility provides medical services
and care to an average of 25 or more patients during each business day in the
immediately preceding calendar year, the Division shall:

1. For a hospital described in NRS 439.805, divide the total
number of inpatients admitted to the hospital during the preceding calendar
year by 365.

2. For a medical facility other than a
hospital, divide the total number of patients seen by the medical facility in
the immediately preceding calendar year by the total number of days on which
the medical facility was open for business during that calendar year.

1. Each medical facility that participates
in the National Healthcare Safety Network shall:

(a) Subscribe to the National Healthcare Safety
Network user group designated by the Division.

(b) Comply with the requirements of the Centers for
Disease Control and Prevention of the United States Department of Health and
Human Services for enrolling and maintaining enrollment in the National
Healthcare Safety Network.

(c) Comply with all definitions, methods, requirements
and procedures established by the Centers for Disease Control and Prevention
when collecting and submitting data to the National Healthcare Safety Network.

(d) Designate a person employed by the medical
facility to act as the facility administrator for the National Healthcare
Safety Network.

(e) Designate the persons at the medical facility
who are authorized to access the National Healthcare Safety Network, if the
medical facility determines that such access is necessary.

(f) Complete all training required by the Centers
for Disease Control and Prevention for participation in the National Healthcare
Safety Network and ensure that the facility administrator designated pursuant
to paragraph (d) and each person who is authorized to access the National
Healthcare Safety Network pursuant to paragraph (e) have been properly trained.

2. The person designated as the facility
administrator for the National Healthcare Safety Network pursuant to paragraph
(d) of subsection 1 is the person at the medical facility who is primarily
responsible for accessing the National Healthcare Safety Network and submitting
the required data to the National Healthcare Safety Network. The facility
administrator must:

(a) Have authority to access all data of the
medical facility that is required for submitting information to the National
Healthcare Safety Network;

(b) Be able to certify authorized users who have
been designated pursuant to paragraph (e) of subsection 1 by the medical
facility to access the National Healthcare Safety Network and assist those
persons in accessing the National Healthcare Safety Network; and

(c) Be responsible for accepting official documents
and correspondence from the Centers for Disease Control and Prevention and the
administrator of the National Healthcare Safety Network.

(Added to NAC by Bd. of Health by R044-10, eff. 10-15-2010)

NAC 439.935Participation in National Healthcare Safety Network: Data to be
submitted by each type of medical facility. (NRS 439.847, 439.890)

1. Each hospital described in NRS 439.805 that is required to
participate in the National Healthcare Safety Network shall:

(b) Commencing not later than February 1, 2011,
submit data to the National Healthcare Safety Network relating to the
nosocomial methicillin-resistant Staphylococcus aureus infection rate of
patients for each patient care location within the hospital that has been
identified by the Centers for Disease Control and Prevention.

(c) Commencing not later than February 1, 2011,
submit to the National Healthcare Safety Network the incident rate of
hospital-onset methicillin-resistant Staphylococcus aureus bloodstream
infections, which must be based on clinical cultures, for each patient care
location within the hospital that has been identified by the Centers for
Disease Control and Prevention.

(d) Commencing not later than February 1, 2011,
implement the Antimicrobial Use and Resistance Option within the
Medication-Associated Module of the Patient Safety Component of the National
Healthcare Safety Network.

(e) Commencing not later than June 1, 2012, submit
data to the National Healthcare Safety Network concerning surgical site
infections relating to a:

(1) Coronary artery bypass graft with both
chest and donor site incisions;

(2) Hip prosthesis;

(3) Knee prosthesis; and

(4) Laminectomy.

Ê Each hospital
shall continue to report the information required pursuant to this subsection
to the National Healthcare Safety Network at the times and in the manner
prescribed by the National Healthcare Safety Network for submission of that
information.

2. Each surgical center for ambulatory
patients described in NRS 439.805
that is required to participate in the National Healthcare Safety Network shall
submit data to the National Healthcare Safety Network concerning surgical site
infections relating to a:

(a) Gallbladder surgery;

(b) Open reduction of a fracture;

(c) Herniorrhaphy; and

(d) Breast surgery.

Ê Each surgical
center for ambulatory patients shall continue to report the information
required pursuant to this subsection to the National Healthcare Safety Network
at the times and in the manner prescribed by the National Healthcare Safety
Network for submission of that information.

3. Each independent center for emergency
medical care described in NRS
439.805 that is required to participate in the National Healthcare Safety
Network shall submit data to the National Healthcare Safety Network concerning
the influenza vaccination rate of the health care personnel of the center. Each
independent center for emergency medical care shall continue to report the information
required pursuant to this subsection to the National Healthcare Safety Network
at the times and in the manner prescribed by the National Healthcare Safety
Network for submission of that information.

4. Each obstetric center described in NRS 439.805 that is required to
participate in the National Healthcare Safety Network shall submit data to the
National Healthcare Safety Network concerning the influenza vaccination rate of
the health care personnel of the center. Each obstetric center shall continue
to report the information required pursuant to this subsection to the National
Healthcare Safety Network at the times and in the manner prescribed by the
National Healthcare Safety Network for submission of that information.

5. A physician who performs a medical
procedure at a medical facility that is required to report to the National
Healthcare Safety Network shall report to the medical facility any
facility-acquired infection which is diagnosed at a follow-up examination of
the patient and which resulted from the medical procedure performed at the
medical facility.

6. A medical facility shall report all
confirmed and all suspected instances of a facility-acquired infection acquired
at another medical facility to the medical facility in which the infection was
acquired. The medical facility which reports a confirmed or suspected instance
of a facility-acquired infection pursuant to this subsection shall keep a
record of that report for not less than 3 years after making such report.

1. Except as otherwise provided in this
section and NRS 239.0115,
information provided to the Division through the National Healthcare Safety
Network and any additional information requested by the Division is
confidential, not subject to subpoena or discovery and not subject to
inspection by the general public.

2. The Division shall annually prepare and
post on the Internet website maintained by the Division a report of aggregated
data provided to the National Healthcare Safety Network.

3. The Division may prepare and post on the
Internet website maintained by the Division a report of the data provided by a
specific medical facility, including, without limitation, infections tracked by
the medical facility, infection rates reported by the medical facility and the
name of the medical facility, if:

(a) The medical facility has given the Division
permission to make such a report available to the public; and

(b) The data released pursuant to this subsection
does not reveal the identity or otherwise compromise the confidentiality of a
medical facility that is included in the report of aggregated data posted
pursuant to subsection 2 and which has not given the Division permission to
report data specific to that medical facility.

4. The Division shall:

(a) Ensure that the name and other personally
identifying information regarding each patient are kept confidential when
preparing the report.

(b) Adhere to standard methods of suppressing
protected health information and reporting to ensure that the identity of a
patient is not revealed and to preserve patient confidentiality.

5. The Division may, at such times as it
deems necessary, audit a medical facility that participates in the National
Healthcare Safety Network to ensure the accuracy of information submitted by
the medical facility, including, without limitation, data relating to
facility-acquired infections, health care records and tests.

1. If a medical facility participates in the
National Healthcare Safety Network, the chief executive officer of the medical
facility, or the officer’s designee, shall, on or before March 1 of each year,
submit to the Division a signed statement certifying that the medical facility
has processes in place to ensure that the data relating to facility-acquired
infections submitted to the National Healthcare Safety Network is accurate and
meets the requirements of NAC 439.900 to 439.945, inclusive.

2. The signed statement required by
subsection 1 must be mailed to the Bureau of Health Care Quality and
Compliance, 727 Fairview Drive, Suite E, Carson City, Nevada 89701.

(Added to NAC by Bd. of Health by R044-10, eff. 10-15-2010)

MISCELLANEOUS PROVISIONS

NAC 439.700Appointment
of deputy attorney general to represent Division of Public and Behavioral
Health. (NRS
439.190, 439.200)The
Division of Public and Behavioral Health of the Department of Health and Human
Services may request, at least 10 days before a hearing, that the Attorney
General appoint a deputy attorney general, separate from the deputy attorney
general representing the State Board of Health, to represent Division before
the Board.